Spotlight: Jessica Downs, Clinical Operations

HealthStar’s Corporate team is a very diverse mix of all walks of life. Today, we are nurses (like Jessica), medical billers, and office support staff. But many winding paths have converged to bring this team together. With history in auto maintenance, real estate, finance, marketing, teaching, and even some folks who moved to the continental US from abroad, we really keep things interesting!

We are all problem solvers in one way or another, but the thing that really brings us together is our love of caring for others. We may not be direct, hands-on care staff, but we show our helping hands in other ways. There are lots of treats and shared meals, plenty of “feelings Friday” discussions where we show our support for each other, and lots of inside jokes. There are no cliques – we all get along. No, seriously! It’s not always easy, but because we truly care about each other, we give each other grace and try to understand where others are in their own unique battles.

As awesome as Corporate is, if you really want to see what makes HealthStar shine, what sets us apart, and what we are all working for every day – you’ll need to look outside our colorful and multi-angled Corporate walls. Look out into “the field,” where the rubber meets the road. Can you see our clinicians, our practitioners, and our front-line caregiving staff? Maybe you also see our service office locations and some of our Clients – they’re the reason Corporate exists! We work to serve, and we work hard to make sure that we serve well!

Who else do you see?

While you’re looking out there, do you see a blonde? Not just any blonde, but a blonde who really OWNS IT? Maybe you see her climbing out of a big pickup truck with her hair flowing in the wind. Her broad, radiant, feel-good smile touches everyone she walks past. That blonde hair is a statement, and the shoes and smile are the exclamation point. Her red shoes reflect her true passion – love for all people, and a strong desire to take care of those who need it. Watch out, now – she’s a hugger, but her hug melts your worries away and leaves you feeling lighter. Just who is this happy, high-heeled hugger, you ask? I’m proud to say, this bright and bubbly blonde is Jessica “Jess” Downs, HealthStar’s Director of Clinical Operations.

Talk about winding roads to HealthStar Corporate – prior to her decision to become an RN, Jessica had worked as a CNA in HealthStar’s Duluth office. Jess even once considered becoming an attorney! We’re sure glad she didn’t go that route. Instead, while working as a CNA in a nursing home, Jess was encouraged by a mentor to pursue a career in nursing and decided to give it a try.

What a great fit for her caring personality! After getting her degree, Jessica’s career in nursing kicked off in her home town of Duluth, MN, working in a surgical center and hospital. She later worked in Wisconsin, Nevada, California, and Arizona, in a variety of clinical roles including corrections nurse, hospice case manager, and Director of Nursing. Then, in 2014, Jessica’s winding road led her full-circle right back to HealthStar. Some things are just meant to be! Because we are in the “month of love,” we thought it would be a great time to tell you a little more about Jessica and her big-hearted ways. Jessica Downs, the HealthStar spotlight is on you!

Happiness is contagious

One of the first things that I noticed about Jessica is that she always seems So Happy. It’s an overwhelming happiness, like I imagine it would be if everyone’s Facebook self was real. She projects positivity and happiness into the world in front of her, like a blinding pink tractor beam, daring sadness to cross its path. If ethereal auras were visible, Jessica’s would be pink and fuzzy, and it would probably sparkle in the sunlight.

Cass Lake 2018 Holiday Party.
Left to Right: Barb J, Michelle C, Julie S, Jessica D, Jean B.

Her happiness is wonderful in meetings, which are otherwise often dull and boring. Jess has a great laugh, bursting straight out of her heart; it is the glorious sound of freedom, a bird’s song of warm sunshine and wind ruffling his feathers as he soars through the open sky. Try to be stressed and frustrated in front of Jessica, I dare you. When you start to explain your problems, they suddenly won’t seem so bad any more. She’ll tell you “it’s OK, we’ll get through it.” And, poof – she’s right. It’s that simple. We will get through it.

Shine on, Jessica!

It’s easy to understand Jessica’s success in hospice, and as a nurse in general. A ray of sunshine in a cloudy and often difficult time, she’s exactly the type of personality to lift everyone’s spirits. Picture her sweet-talking her patients and showing them there’s nothing else that matters in the world. To Jessica, that’s the truth! She loves our HealthStar clients and pours her heart and soul into making sure that our team has the tools to deliver the best possible care!

While similar care is provided in both hospice and home care, there is a much more personal aspect to home care, because of the need for service to be provided in the Client’s living space. Jess has a great understanding of what this means to Clients. She expresses gratitude and compassion toward HealthStar’s Clients and says that she is honored to be invited into their homes. Her humility and friendliness help set Clients at ease.

Flexibility, much?

Some things are critical to a successful career at HealthStar. A sense of humor, I say. A love of food? Probably. The gift of patience? Can’t hurt. How about the ability to roll with the punches, to re-prioritize when a target shifts, or to “be the willow,” as our long-time employee Cathy Rivas-Carballo says. In my opinion, this is critical. HealthStar staff have an informal motto: “Give it a minute, things will change!”

Cass Lake 2018 Holiday Party.
Left to Right: Michelle C, Karen M, Jean B, Jessica D, Julie S.

Why is flexibility important? Take Jessica’s HealthStar history as an example. In her RN role, she started at HealthStar shortly after our transition from PCA/HMK agency to Medicare-certified agency. In the time Jess has been with us, the layout, structure, and focus of HealthStar’s branch offices, the organizational chart, and even our office addresses have changed. We have added and subtracted service offerings, and we have changed software programs many, many times. Staff have come and gone, sometimes more than once. (We joke about a revolving door. In a good way!) Throughout all these changes, Jess and the rest of our Corporate staff have flexed and sometimes flailed in the wind, but with flexibility on our side, we haven’t broken. We almost never make jokes about having a new priority. Instead, we come together as a team, again and again, and figure out how to continue.

But wait, there’s more…

Jess has also ridden the wave of change in her personal journey at HealthStar. Not including her time as CNA, Jessica first worked at Corporate, transferred to Duluth, transferred back to Corporate, and now lives in the Duluth/Cloquet area but still represents the Corporate office. Wait, what? Don’t worry about the details; the moral of the story is, she’s plenty flexible, and she goes with the flow. Jessica’s humility and “true to your roots” attitude make her approachable, and she always talks us down off the branches when things get a little too windy in that willow tree.

Open heart, open mind

Something that not everyone may know about Jessica is that, in addition to being an RN, she embraces a very unique skill set of healing. She is a Certified Level II Reiki Practitioner and says that blending western medicine and alternative medicine helps her to treat people holistically. Reiki has been around for thousands of years and is sometimes called “the laying of hands.” In practice, Reiki focuses on the transfer of healing energy from practitioner to patient, to revitalize the healing energy in the patient.

Maybe this explains why Jess has such grace and love for all of us – by sensing the energy around her, she sees more than just a single facet of a person, giving her a greater understanding of what makes us all tick. By keeping an open mind, and trying something different, Jessica is bringing a new perspective to HealthStar. There is something different about Jessica, and maybe this explains a little bit of that difference. There’s a lot that we can’t fully understand, but instead of dismissing those things, Jessica has embraced possibility and puts healing energy to great use.

But what about those shoes?

Yes, Jessica has some of the cutest shoes that I’ve ever seen. With my big clompers, I won’t be wearing anything like her shoe wardrobe. She’s not shoe crazy, she just has good taste. I know, this is four things, and usually I only do three, but this one is short. Great shoes. Hardly counts as a fourth.

By the way, Jess – how do you drive that big pickup truck with those fashion forward shoes on? And do you still wear heels when you go ice fishing?

Thanks for the positivity!

Corporate is lucky to have Jessica’s happiness, positivity, flexibility, and open mind on our side. Her love of HealthStar’s Clients shines through in every meeting. She is absolutely a strong advocate and spokesperson for the Client’s perspective and needs in receiving care. Jessica has brought a wonderful attitude of love and acceptance to HealthStar Corporate, and she has extended that attitude to the branch offices and to all of our Clients. We can’t wait to show you the benefits of this sense of love and caring!

Spotlight: Cristina Hernandez, TC Skilled

Checking her list

Turn the computer on, then check in with “the boss,” Deb Allen in Twin Cities Skilled. Another check-in with “the other boss,” Donna Smith in HR. Pull up Outlook and check Tim’s schedule. Check Barb’s schedule. Make sure there’s enough paper, water, plastic silverware, pens, and post-its. Check the main fax. Sit down and check Corporate voicemail. Check email. Look for IT inventory to check in or check out. How much checking can one person do in a day! And it’s only been 15 minutes.

This is the beginning of a typical weekday for Cristina Hernandez, Office Assistant at HealthStar’s Corporate and Twin Cities Skilled office. She keeps us all organized, on-time, and well-stocked with legal pads. She has a great sense of humor and loves practical jokes, but be warned; if you pick on her way of eating fried rice, one grain at a time while picking all of the vegetables out, you might upset her. She does have her sensitive side.

A little history

Cristina started at HealthStar in June of 2015. She worked as a HMK/HHA/PCA for the Minneapolis South office on Franklin, and she provided administrative support to the office between visits. In October of the same year, she applied for a position at the Corporate office. Corporate snapped her up before the ink dried on her application.

Cristina has been a great addition to the Corporate team, and is now working most often with the Twin Cities Skilled team. There is a lot to love about Cristina; just ask her. She’s not shy about her talents and will tell you the same. She has three unique and special talents, though, that make her really stand out from the crowd. Cristina, the HealthStar Spotlight’s on you! Let’s see what makes you shine!

Love yourself, first!

Cristina is very confident and self-assured. This makes her a great fit at the front desk, because she doesn’t shy away from meeting new people, and she is very comfortable in new situations. Cristina easily befriends any person in her path. She is charismatic and speaks her mind, but her sense of humor and kindness help to temper her strong personality.

Cristina can liven up a dark day, and she uses that skill to help motivate the Corporate and Skilled teams, from the lowest member right up to the very top. We have all witnessed the effect of her motivational skills on Tim Lively (owner/CEO). Only Barb Jezorski, Executive Director, can compete with Cristina when it comes to motivating power. When Barb and Cristina combine forces, Tim stays on schedule, on time, and on target! Corporate staff love it, because without Cristina, we wind up playing “oh where oh where has my boss’s boss gone.” It’s a lovely tune, but when you’re trying to plan your day, it can be a challenge. We like Cristina’s way much better.

Tell us a story

My personal favorite thing about Cristina is that she is an amazing source of information about Latino culture, and she’s a captivating storyteller. It is fun to learn about her Puerto-Rican background! I love when she tells us about the sights, the smells, and the sounds of Puerto Rico. I especially like learning about the food that Cristina’s family used to cook for her when she was growing up. Cristina is also willing to give me tips about speaking Spanish. She’s not afraid to correct my grammar or pronunciation (she’s brutally honest, have I mentioned that?). I have also learned this very important lesson from Cristina: just because two people might both speak Spanish, they don’t necessarily speak it the same way, or share the same cultural background. It is very interesting to learn of the many differences between Spanish-speaking cultures!

Cristina sometimes provides backup to the lovely and talented Nilda Garcia, Program Manager of Sagrado Corazón. Thank goodness for them both, because according to Cristina, my Spanish skills are not quite ready for prime time. HealthStar’s Spanish-speaking Clients might not be as patient as Nilda and Cristina when I take 5 minutes to think of the right word for Cucumber. (By the way, Concombre is French, not Spanish. You can guess who corrected me on that…)

But how are you feeling, really?

This is a special skill that I really admire in Cristina. She knows how to read people. She can be the most caring and patient person, if that’s what you need her to be. But in a heartbeat, she can turn on a fiery personality and liven things up with her high energy and flair. She takes the time to really listen to our Clients’ needs, making each Client feel like there is nothing else going on in the world. Clients would never know that she is also being pulled by multiple departments to help with their workloads. Cristina’s honest and open communication style sets people at ease in difficult situations. Most of all, she is passionate about meeting our Clients’ needs, whether it means translating at visits, providing direct care with grace and a gentle touch, or just listening and being compassionate when someone calls with an issue.

Family Connections

Some fun facts about Cristina’s family: Cristina’s mom, Marisol, has also worked at HealthStar. She provided HHA service out of the Minneapolis South office starting in 2011, and she reigned supreme as temporary queen of Corporate file retention in 2018. She is our favorite employee mom, because she makes the most amazing cakes. We miss you, Marisol – please come and visit soon!

There is another family connection, too. Cristina’s first experience with home care was when her brother, Jomar, received home care services through another agency. This was several years before Cristina joined HealthStar, and showed Cristina the impact that home care services make! Growing up with Jomar, with her family supporting his unique needs, Cristina developed the patience and compassion that make her such a great fit at HealthStar. Jomar is doing great and now lives in his own place. We all joined Cristina in celebrating his increasing independence, and we always enjoy hearing about his progress!

HealthStar Needs You, Cristina!

Corporate wouldn’t be the same without Cristina. I know, because I was here before she joined the team. It was a dark time, and we certainly don’t want to go back! Cristina has big shoes to fill, but the great thing is, she has big feet, so we never have to worry. She handles all her tasks with determination, and she keeps her sense of humor handy when things get tough. She’s a critical piece of the Corporate team!

Want to know more about what it’s like to work at Corporate? Check out our other articles and see which positions we’re hiring for today!

Footnote:

After reviewing this article, Cristina was disappointed that I didn’t discuss her amazing video editing skills. This is a unique talent, but it doesn’t seem to fit into any of the three very personal talent areas that I have clearly outlined above. Instead of adding a fourth talent category just for video editing, I told her that I would add a footnote. Cristina, I sincerely hope that you are now satisfied with this article. I don’t want to upset you, like that time I picked on your rice eating style.

Spotlight: Nilda Garcia, Sagrado Corazón

Nilda Garcia and Sagrado Corazón: HealthStar’s Spanish-Speaking Support Service

Spanish-speaking Clients of HealthStar are very familiar with Nilda Garcia. She is the warm and caring voice of the Sagrado Corazón (Sacred Heart) program for Latino Clients of HealthStar. For 10 years, Nilda has been putting her “special touch” on everything that she does, from event planning to office organization and troubleshooting IT problems. With her recent promotion to Program Manager of Sagrado Corazón, Nilda is ready for action with renewed energy and focus. Nilda, the HealthStar Spotlight is on you!

A little history

Nilda has been with HealthStar since 2008, when she started as an Assistant Program Coordinator in HealthStar’s basement suite on Bloomington and 21st. Then, in 2009, Nilda helped open the West St. Paul office – the original home of Sagrado Corazón. But don’t get too comfortable, Nilda! Just a year later, HealthStar moved from the location on 21st into another building on Franklin Ave in Minneapolis. The West St. Paul office merged into the new location as well.

Nilda made the Franklin office her new home as an Assistant Program Development Liaison. She worked in the community and continued as primary contact for Sagrado Corazón. During the next 2 years, Nilda helped HealthStar achieve Medicare certification and had a front-row seat for the beginning of HealthStar’s Mental Health initiative. In 2010, Nilda watched Corporate move from Maplewood to a new building in North St. Paul. Then, In 2017, the Franklin office moved to a new location in Inver Grove Heights. Once again, Nilda unpacked and organized a new space. This new location is beautiful, with big windows and lots of wild turkeys outside! It’s a great place to re-focus and re-energize. Throughout all these changes, Nilda’s positive attitude and sense of humor kept her office mates in good spirits!

 Nilda, how do you do it all?

So, what makes Nilda tick? How can she weather all these changes and still be a constant source of positive energy? A secret about Nilda – she has superpowers. Lots of them. I’ll tell you about some, but you must promise not to say that I told you. Nilda doesn’t like to be the center of attention and won’t want everyone talking about her special abilities.

Superpower #1

Nilda’s first superpower is that she is amazing with event planning. She loves to get people together and celebrate! Nilda’s smile and laugh bring light and joy to the group. She is a great cook and loves to try new foods. Nilda says that her favorite thing about HealthStar is the family atmosphere. Working here is like working at a family gathering, because you’re surrounded by happy people who care about each other. Nilda fondly remembers when a special Client celebrated her 100th birthday last year – with Nilda at the party, of course! Nilda especially loves planning events for Sagrado Corazón, because she gets to use one of her other superpowers – the Latina superpower!

Superpower #2

Nilda’s Latina superpower comes from her family in South Texas, on the border of Mexico. Nilda loves to celebrate her Latina roots with the Sagrado Corazón team. She is always willing to help teach a little Spanish on the side, which has been one of my personal favorite things about working with Nilda. She is a very lenient Spanish teacher, unlike Cristina Hernandez, Corporate and Twin Cities Skilled Admin – also a superpowered Latina, but much stricter in the Spanish-speaking department! A little-known fact is that Nilda is close friends with Cristina’s mother, Marisol. Get them together, and I can only imagine the cooking and laughing!

Superpower #3

The last superpower that I will reveal about Nilda is that she is a multi-talented and very organized superheroine. She processes payroll, troubleshoots technology issues, and answers phones in two languages (backing up the lovely and talented Barbara Edwards at IGH), all while drinking her French vanilla coffee and running around in her high heels. Nilda is a positive force at the Inver Grove office, keeping things fun and exciting for the team. She has a fabulous sense of humor and is not afraid to pull pranks to get everyone in a good mood. She once dressed up the CPR dummy and scared RN Sue Schaber by leaving it in the bathroom overnight. Boy, was Sue surprised when she came in early thinking she had the office to herself!

Nilda says that her greatest accomplishment at HealthStar is learning to walk in another person’s shoes. She appreciates learning with her team and is grateful for the opportunities that HealthStar offers for personal and professional growth. She knows that she has great things ahead with Sagrado Corazón, and is looking forward to putting renewed focus and energy into the program. We hope you’ll check out what Sagrado Corazón has to offer, and learn more about our awesome team!

Spotlight: Nissa Fougner, Rehab Therapies

We all have days when we don’t feel motivated or just can’t get going on a project. We’ve all felt sluggish and tired, or maybe even <gasp> a little cranky. Some people are far less obvious about this than others. We know they must have bad days, too, but we can’t tell when it happens. Think about the people you know. There’s probably someone who never seems down and out, and who always has a smile and a little pep in her step. For HealthStar Corporate, this is Nissa Fougner. She is a ray of sunshine from morning till closing time. Quick to smile and always full of energy, she flits to and fro like a healing honey bee, spreading the sweetness of optimism, better health, and rehab plans all along her path.

A little history

Nissa grew up in International Falls, MN. She’s as midwestern as it gets – she has experience giving skating lessons and coaching figure skating. She found a passion for rehab therapy while she was in college at Gustavus. Home care won her heart with the promise of flexibility. Nissa also loves that she gets to see her clients in their own home environment, where she can start making a positive impact right from the first visit. Each client has unique needs as well as a unique situation, and Nissa is proud of the improved quality of life that she helps her clients achieve.

Nissa first worked with HealthStar as a contractor doing therapy case review. After she heard the legend of the HealthStar Potluck, she converted and became one of us! (at least, we think it was the potluck legend…) Nissa has been working in the Corporate office as Director of Rehab Services since February 2018. She is so quiet that a lot of our staff didn’t realize she had moved in until July. Nissa’s favorite thing about HealthStar is the people, because “everyone is so friendly and helpful.” That’s why we call it the HealthStar family! We’re pleased to have Nissa on our team, and we’d like tell you about a few of her amazing skills. Nissa, the HealthStar spotlight’s on you!

The skill to celebrate small victories

So often, we celebrate only after a task is completed, forgetting to celebrate the milestones that pass along the way. Nissa doesn’t let those milestones pass in silence! She has a talent for appreciating and recognizing progress, even small progress, toward big achievements. She breaks down big, challenging goals into smaller, more approachable pieces. There is an old proverb that says, “a journey of a thousand miles begins with a single step.” By looking at the little steps instead of the miles, Nissa gets people moving! Acknowledging progress along the path makes Nissa an encouraging coach and teacher, and helps her clients to stay motivated even when there is still a long way left to go.

The skill of humility

I haven’t known Nissa for a long time, but I have already learned that she is very modest. She is somewhat reserved, although she can crack a joke or two when she’s feeling feisty. Even when she is given a direct compliment, she half brushes it off and half explains it away. For example, the secret to always looking like you just stepped out of a chic boutique – it’s not “yeah, I know, I’m an amazing shopper,” but instead it’s a laundry tip. Wash your clothes on the cold/gentle cycle, and always line dry.

Nissa takes this same sense of place into the community when she meets with Clients. Meeting her for the first time, you might feel as relaxed as you would with an old friend. She keeps a low profile, and never casts a judgmental glance. Gentle, respectful, and mild-mannered, Nissa makes her mark by smiling us all into a calm and tranquil state of comfort and positivity. After being around Nissa, I challenge you not to feel better than you did before!

The skill to be absolutely adorable

Everything about Nissa says, “I’m safe and friendly.” She’s like the human equivalent of a daisy or a kitten. Corporate staff love to see what she’ll be wearing each day, and we all want to know her secrets to beautiful skin and hair! She always looks put together and approachable; she makes people around her smile just by being there. This combination is fabulous, considering that her goal is motivating the heck out of her Clients! Her easy smile and comfortably classy wardrobe set Nissa’s clients at ease, but all the while she sneakily (and very gently) pushes them to meet and surpass their goals.

But how strong is she?

Nissa has demonstrated her strength while also giving a short lesson on proper form for changing out the Culligan water jug in the Corporate office. By size and weight, the Culligan water jug outranks Nissa two to one. Nissa says, the proper technique for lifting something that’s larger and heavier than you are is to hold it close to the body, lift with your legs, brace your core, and hope that you don’t injure anything important. (ok, ok – she didn’t say the part about not injuring anything important, but I think it should be mentioned.)

She’s not just strong in body. Nissa has great experience in therapies, and she provides wisdom and encouragement to HealthStar’s therapy staff. HealthStar’s rehab therapy program is in great hands!

Put it all together – she’s perfect for Rehab Therapies!

Nissa is like a cool, sparkling stream – strong enough to turn a boulder into a pebble, but gentle and inviting enough for a refreshing soak of legs and feet on a hot day. Like the stream, she doesn’t seek credit or acclaim. She takes pride in helping others reach their goals, knowing that their success is her success as well. HealthStar is stronger (and more charming) with Nissa leading rehab therapies! We are so lucky to have her on our team!

 

Understanding Alzheimer’s

Alzheimer’s contributes up to 80% of dementia cases nationwide, and is a terrifying diagnosis. When faced with the possibility of total memory loss and death, it’s understandable to be worried about this degenerative illness. After receiving an Alzheimer’s diagnosis, recognizing the first signs and symptoms, as well as understanding all available treatment options, can help the care process moving forward quicker and easier.

Alzheimer’s disease is not a normal part of aging, and is not just a part of getting old. Some memory loss can be contributed to the eventual aging-process, but Alzheimer’s is a much bigger problem. Alzheimer’s is a progressive disease, meaning that individuals who are affected will have worsening symptoms with no chance of recovery. Because there is currently no cure, the best option available is to slow the symptoms and continue to improve quality of life for those affected. Most families look to qualified, compassionate, and trained caregivers to assist in the day-to-day tasks of an Alzheimer’s patient. Having an understanding and efficient home aid, or transferring a patient in to an assisted living facility can greatly increase their quality of life by allowing them autonomy over their daily living with increased assistance. Getting the help needed for Alzheimer’s disease in Minnesota is easy—and finding the right assistance can be a life-saver.

10 Warning Signs of Alzheimer’s

  1. Forgetting important dates, asking for information again and again, or not remembering family members’ names.
  2. Sudden inability to solve problems, like balancing a checkbook, or cooking a family recipe. They may also take much longer to complete tasks that were previously easy.
  3. Cannot complete or remember how to do daily tasks that they frequently did previously, like working the television remote, or the rules of a game.
  4. Can no longer understand times and dates, as well as seasons. They may forget a planned outing altogether, or not comprehend when it is happening. They may also suddenly realize they can’t remember how or when they arrived somewhere.
  5. Difficulty reading or understanding visual information. This includes lack of depth perception, or loss of contrast in vision.
  6. Loss of words or their meaning. An affected individual may call things by the wrong name, or make up a word. They often lose their place in conversations, and repeat themselves several times.
  7. Often, they will misplace things and be unable to remember where they put them, or even when they had the item last. This may lead to accusations of stealing and frustration.
  8. Poor judgment is another warning sign—if the person makes poor choices when handling money, and struggles to remember to bathe regularly.
  9. Suddenly become withdrawn from work or social activities, or no longer enjoy hobbies, projects, or sports that they once loved.
  10. Changes in mood and personality are warning signs of Alzheimer’s disease. If the patient appears depressed, anxious, or more easily frustrated than usual, it may be time to talk to a doctor who specializes in Alzheimer’s disease in Duluth.

If you have a loved one showing any of the early warning signs of Alzheimer’s, know that HealthStar can help! We offer free in-home consultations to help find the right care for your loved one. For more information, please call 612-871-3700.

A Day in the Life of a Psychiatric Field Nurse

7:00 am: Amelia Muir, psychiatric home care nurse begins her day by logging into her laptop. After checking e-mails and confirming appointment times with patients, Amelia is ready to enter the field for her four scheduled home visits in Queens, New York. Queens, a borough of New York City, is home to more than 2 million residents and is considered one of the most diverse areas in the country.

8:00 am: Amelia’s first visit is to see Ms. A., a 62-year-old woman who has been living with HIV for the past 25 years. Ms. A. was referred to Amelia by her caseworker, who noticed signs of depression and anxiety following a recent hospital admission. For the first 30 minutes of the visit, Amelia provides counseling to Ms. A. using cognitive behavioral therapy techniques, which aim to help her reframe negative thought patterns and begin to change ineffective coping mechanisms. After her patient has had the opportunity to express her feelings openly, Amelia shifts the visit to focus on specific symptoms she and Ms. A’s doctors have been closely monitoring. The home care visit is a vital way to keep doctors updated on a patient’s condition as many patients feel certain symptoms are either not important enough to call their doctors or nurses about.

The last 15 minutes of Amelia’s visit with her patient focuses on goal setting and educating the patient about her recommendations for whatever issue they had been discussing. In addition to patient-centered goal setting, Amelia also adds her own suggestions, such as taking a walk around the neighborhood with the home health aide for exercise and stress relief, calling an old friend, or taking time to sit down with a good book. “Many of my depressed patients are in need of more joy in their lives. It may seem overly simple but with the right frame of mind, escaping into a novel or a hobby can have noticeable effect on someone’s mood.” To close the visit, Amelia reviews a list of important symptoms to report to her nurse or doctor with Ms. A. Establishing good communication between patient, nurse, and doctor helps prevent hospitalizations by addressing issues at the earliest appearance. Ms. A. tearfully hugs Amelia at the end of most visits and thanks her for her support. The authentic relationship established between clinician and patient after weeks or months of working together cannot be understated.

Back in her car and mobile office, Amelia checks voicemails and e-mails from other clinicians and patients. Between every visit, arise that require careful coordination. It is often said in the office that being in the patient’s home is the easy part, meaning the real work is often done by clinicians behind the scenes. The case management aspect of home care nursing can drive the stress level up in this specialty.

10:00 am: Amelia’s next patient is Ms. G., a 74-year-old who is experiencing a high level of anxiety because of her progressing amyotrophic lateral sclerosis disease. Amelia has been coming for several weeks after Ms. G.’s daughter begged her to accept psychiatric treatment when she noticed her mother’s motivation to care for herself significantly declined. The first half of the visit is again focused on allowing the patient to have time to express her feelings openly to her nurse. Ms. G. describes how her breathing has become more difficult. One of the interventions Amelia teaches her is how to preform deep abdominal breathing exercises to decrease anxiety and improve lung expansion. She also recommends that Ms. G. play classical music during this exercise to give an added stress-relieving quality. After reviewing goals for the week and target symptoms to report, Amelia begins a short relaxation exercise with the help of aromatherapy oils and acupressure. “I love home care because I have more flexibility to try different strategies with my patients.” Using a simple acupressure technique on both hands creates a calming sensation for Ms. G. She teachers her how to use this technique on her own.

Technology is also an important part of Amelia’s teaching strategies for patients who have access to computers or tablets. Ms. G. was an accountant before she retired 3 years ago and is part of a growing group of tech-savvy seniors. On and earlier visit, Amelia helped Ms. G. explore Web sites, such as YouTube, that provide free instructional videos on topics relevant to the wellness teaching she provides including guided meditation, chair yoga for seniors, and breathing exercises. Ms. G. is also learning to use her tablet for recreation, “I love the videos of the New York City Ballet. It brings me back to when I could move like that!”

1:00 pm: At a nearby apartment complex, Amelia greets her next patient’s wife, who is the primary caregiver for her husband. Mr. C. is in the middle stages of Alzheimer’s disease and has been experiencing many behavioral changes that have caused great stress for his wife. Amelia sits down with the couple in their brightly lit kitchen and reviews symptoms over the past week. During her visits, Amelia explains the different stages of his illness, communication techniques, safety precautions, tips for managing insomnia, and encourages Ms. C. to keep her husband’s mind stimulated with structured activities and recreation. Another important topic Amelia covers is caregiver burnout and she encourages Ms. C. to take time for herself whenever possible.

3:00 pm: For her last visit, Amelia visits Mr. B., a man in his late 50s who is now homebound as a result of Parkinson’s disease. Despite increasing physical challenges, Mr. B. is determined to stay as independent as possible and spends 3 days per week doing intensive treatments with a physical therapist. Amelia visits this patient every 2 weeks to fill his medication box as muscle weakness in his hands prevents him from doing this for himself. Mr. B. updates Amelia on symptoms over the past week and excitedly discusses his progress with his rehabilitation program. Amelia finishes the visit with a quick check on his vital signs.

At the end of her visit, Amelia returns back to her car to make the trek back to her home where she will complete her visit notes and make some final calls to doctors. After another emotion-filled day, Amelia tries a breathing exercise of her own. “Helping patients with depression and anxiety can take an emotional toll on clinicians and it’s vital for me to have self-care rituals so that I don’t become burned out,” adding “I want to do this work for the rest of my career and my goal is to take good care of myself along the way.”

Written by Amelia Muir, BSN, RN-BC

Amelia Muir is a Psychiatric Field Nurse, Behavioral Helath, Visiting Nurse Service of New York, New York City, New York.

Managing Holiday Stress

For some, the holiday season is “the most wonderful time of the year” but for those with mental health issues, seniors and caregivers, it’s also a time that manifests hopelessness and loss. People often get caught up in the commotion the holidays bring with all the extra commitments, emotions and expectations, making it easy to lose focus. Before you know it, stress and depression have taken over and it’s tough to dig yourself out, especially for those already dealing with mental health issues. It may sound simple, but what can help is to remember what matters most in life.

Here are some reminders to keep you focused on what’s important this holiday season in order to stay healthy both mentally and physically.

Keep it Real. As much as you may want the holidays to be perfect for you and your family, let’s be realistic… they aren’t. And that is ok! When life throws you a curve ball in the way of travel delays from the icy Minnesota roads, poor health or an unfortunate accident, try to adjust and go with the flow. Even your long-standing holiday traditions over the years may need to adjust to accommodate changes that come your way. Who knows, you just may find a new favorite tradition!

Plan ahead. Schedule time to do your shopping, baking and extra activities. If you don’t plan out your day, it will easily get away from you and then you’ll be rushing to get things done or end up forgetting something important. If you’re unable to leave a senior or someone with mental health issues that you’re caring for, consider respite.

It’s ok to say no. Decide in advance what is important to you, your family and the seniors in your life, then stick to your plan. You are not a superhero with more hours in your day as your secret weapon so instead, attend the events that are important to you. Spend time with the people you love most and who feed your soul, paying careful attention to avoid those that bring negativity into your life. Your spirit will thank you.

Be Healthy. Daily exercise, good sleep and healthy eating habits will keep you feeling your best this holiday season. It’s ok to treat yourself to the cookies and indulgent meals, but don’t over do it. Weight gain will lead to depression and low self-esteem, which in turn will prevent you from feeling your best. Don’t forget to carve out some time for yourself – take care of yourself first.

Set a Budget and Stick to It. The joy of gift giving will fade quickly if you know you will be buried in debt when the holidays end. Instead, determine a budget that works for you and stick to it. If money is tight, be creative with your gift giving. You can make a donation or volunteer your time to a charity in someone’s name, give the gift of spending time together or give homemade gifts. Your loved ones will appreciate this too, especially homebound seniors.

Volunteer. Volunteering your time is a great way to help those who are less fortunate. There are so many great non-profit organizations in Minnesota that need a little extra help during the holiday season. Volunteering teaches your children the invaluable lesson to give back to their church and Minnesota community. It makes you feel good inside and keeps the holiday spirit alive.

Seek Support If You Need It. Don’t be ashamed or afraid to ask for help if you need it. Spending time with family, friends and your community is helpful in staying healthy, but sometimes you need a little more support. At Healthstar Home Health, we offer Adult Rehabilitative Mental Health Services (ARMHS) for adults 18 years and older who have a qualifying mental illness and are eligible for medical assistance that want to improve their life. ARMHS is not case management or traditional therapy, but instead is mental health services aimed at teaching you skills for managing your mental health symptoms and can get your through the busy, unpredictable holiday season. Contact HealthStar directly by calling 651-633-7300 and ask to speak to a professional in the ARMHS department.